Experts are divided on whether or not Omicron could offer a COVID-19 reprieve.

As the Omicron wave hits its peak in parts of the world, leaving more people infected than in any previous outbreak, some scientists believe that respite is on the way, while others argue another variant could emerge that will be even more infectious or deadly than Omicron.

In the more hopeful camp, scientists say that the accumulation of population immunity – including a high percentage who will have “hybrid immunity” from vaccination and infection – could slow the pandemic at least for a while, if not forever. These experts think that after Omicron, COVID-19 could be reclassified from an epidemic to an endemic disease – a regularly circulating respiratory virus like the flu.

“We have to evaluate the evolution of COVID from pandemic to an endemic illness,” Spanish Prime Minister Pedro Sanchez said last week in an interview with a local radio station that was widely reported by English-speaking media.

On Friday, America’s Dr Anthony Fauci predicted in a White House briefing that background immunity, updated booster shots and new therapies will mean that even if a new variant developed it would “not disrupt us as much as we would have been disrupted” – a sentiment shared by Pfizer CEO Albert Bourla, who told Israeli TV over the weekend that the world should return to “near-normal” within the next few months.

Prof Stephen S. Morse, a professor of epidemiology at Columbia University Mailman School of Public Health, told Health Policy Watch that a pandemic reprieve after Omicron crashes is not only possible but “even seems likely.”

“Omicron has proved highly transmissible,” said Morse. “Its current progress suggests that almost everyone who is susceptible will be exposed fairly soon. At that point, there won’t be enough susceptible people left to keep the infection going.”

Infection is driven by infected people who come in contact with susceptible individuals, he explained. So, the number, or relative proportion of susceptible people is a key factor.

“Once susceptibles are reduced below a certain threshold, which depends mostly on how contagious the virus is, it’s much harder for the virus to find new people to infect, and the rate of infection slows down dramatically,” Morse explained. “This is the promised land of ‘herd immunity’ we often hear about.”

There are already four known endemic human coronaviruses, which surface around the same time as the flu each year, and “we don’t know what the initial introduction of a new human endemic coronavirus looked like, but I suspect it may have been similar to what we’re seeing now with SARS-CoV-2,” Morse said. “With its high transmissibility, Omicron could well be a step on the road to SARS-CoV-2 becoming another endemic coronavirus. Historically, that seems to be how these respiratory virus pandemics ‘end.’”

He said that although immunity to respiratory coronaviruses usually does not last exceptionally long, reinfection often causes only mild or even asymptomatic disease.

“Fingers cross, but there are no guarantees,” Morse said.

‘No law dictating a virus must become milder’

Others are less optimistic.

In a nine-part tweet, Antoine Flahault, director of Geneva’s Institute of Global Health, explained that “endemic refers to a disease that is constantly present in a certain area, irrespective of severity [and] future severity remains a big unknown.

“There is no law dictating that a virus must become milder over time,” he continued. “It is very hard to predict the evolution of virulence.”

8/9 – “Future severity remains a big unknown. There is no law dictating that a virus must become milder over time. It is very hard to predict the evolution of virulence.”

— Antoine FLAHAULT (@FLAHAULT) January 18, 2022

“If there is one word every scientist and policy maker must embrace right now it is humility,” Dr Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) in Minnesota, told Health Policy Watch.

He said he agrees with the idea that the world could go three to five months after Omicron with limited activity like it did last spring after the big January surge. However, he recalled how just as the world started to declare victory, along came Delta and now Omicron.

This could happen again, he said.

“We could see another variant emerge that could evade the current vaccines and could be highly transmissible,” stressed Osterholm, “we just have to be prepared for that too.”

He said the world would be better off to put its money and efforts behind better vaccines and new treatments that could manage future pandemic waves.

CIDRAP is working on a research and development roadmap for better, more effective coronavirus vaccines, though in the meantime Osterholm said getting the world vaccinated with existing jabs plays a key role.

White House Coronavirus Response Coordinator Jeffrey Zients said during Friday’s briefing that fully vaccinated individuals are 16 times less likely to be hospitalized from COVID compared to those who are unvaccinated.

Moreover, according to Centers for Disease Control and Prevention Director Rochelle Walensky, protection against infection and hospitalization with the Omicron variant is highest for those who are up to date with their vaccination, meaning those who are boosted when they are eligible.

A study released Sunday by Israel’s Health Ministry claimed a fourth dose of the Pfizer vaccine for people over the age of 60 protects three times more against serious illness and about two times more against infection compared with people who had only three doses.

But Osterhold stressed, “if we have to keep boosting, we are in trouble.”

Even in the US, where booster doses are readily available, only about a third of those who got two shots are willingly getting the extra jab.

‘Hope is not a strategy’

He said that developing a universal vaccine could take years, however, so in the meantime the focus should be therapeutics.

“We need to do much more in the way of developing a global system for very rapid testing and then making it very clear that these results are returned within hours to individuals and make drugs readily available to people at high risk for developing severe disease,” Osterholm said. “This is something we could do globally and that could occur very quickly – even within a few months.”

The World Health Organization has so far approved a handful of drugs for various stages of COVID-19 and has developed a roadmap for the evaluation and approval of several others. Merck’s oral COVID-19 antiviral medication molnupiravir, which has already been approved by the US Food and Drug Administration, has already signed agreements with 27 generic manufacturing companies to make the treatment readily available in 105 countries, including middle- and low-income countries, the Medicines Patent Pool said last week.

Pfizer’s Paxlovid, which is being widely administered in the US, has also proved to stop severe infection in around 90% of high-risk patients if administered within the first five days of diagnosis.

But in the meantime, Osterholm said, “hope is not a strategy.”

And even those who are hopeful must still be cautious, Morse added.

“We can’t afford to get complacent.”

Image Credits: Flickr: IMF Photo/Joaquin Sarmiento, NBC, Israeli Health Ministry.